Chronic lumbar pain: Facet and radicular blocks guided by computerized axial tomography Experience at the San José hospital Dolor lumbar crónico: Bloqueos facetarios y radiculares guiados por tomografía axial computarizada Experiencia en el hospital de San José

Abstract

Facet and radicular blockages, diagnostic and therapeutic, using only external anatomical repairs as a guide, have been a great tool in the management of chronic low back pain for a long time. Currently, these procedures are guided by images such as computerized axial tomography (CAT) and fluoroscopy. CT has gained ground in recent years, since it allows optimal visualization of the anatomical structures of bone and soft tissues involved, improving the accuracy of the puncture and reducing the possibility of complications. The experience of this technique is presented in the institution with a group of 29 patients attended in the pain clinic, with a diagnosis of chronic lumbar pain refractory to medical treatment and rehabilitation, nine of which were ruled out due to evidence of secondary gain (economic , social or physical) in the psychological evaluation. 23 blockages were made in the lumbosacral region, 18 nerve roots and six facets. Twenty-two procedures were guided by CT and one by fluoroscopy, without technical complications. 95% of patients reported immediate improvement after the procedure, with variable long-term results. There were no technical complications or post-injection complications. It is concluded that the facet or radicular block guided by CT is a precise and safe method, and that the neuroradiologist can contribute his experience in the interpretation of diagnostic images, to be part of the interdisciplinary group of pain.